| Total Life Inc. | |
|
110 Front St Ste 300 Jupiter FL 33477-5095 | |
| (800) 567-5433 | |
| Not Available |
| Full Name | Total Life Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 110 Front St Ste 300, Jupiter, Florida |
| Authorized Official Name and Position | Gerardo Rivera (CLINICAL) |
| Authorized Official Contact | 8559285433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Life Inc. 110 Front St Ste 300 Jupiter FL 33477-5095 Ph: (800) 567-5433 | Total Life Inc. 110 Front St Ste 300 Jupiter FL 33477-5095 Ph: (800) 567-5433 |
| NPI Number | 1053909267 |
|---|---|
| Provider Enumeration Date | 01/04/2021 |
| Last Update Date | 09/13/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 8123433034 |
|---|---|
| Medicare Enrollment ID | O20210225003311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053909267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Primary |
| Provider Name | Sara Trosty Walsh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467400812 PECOS PAC ID: 6204868078 Enrollment ID: I20050901000545 |
| Provider Name | Earl Ledford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215988993 PECOS PAC ID: 9234148933 Enrollment ID: I20060407000115 |
| Provider Name | Lori Kyriacou |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275758476 PECOS PAC ID: 3678664869 Enrollment ID: I20070801000826 |
| Provider Name | Christine A Fanelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790057545 PECOS PAC ID: 2860651643 Enrollment ID: I20120314000476 |
| Provider Name | Emily K Grob |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417456146 PECOS PAC ID: 1254692205 Enrollment ID: I20180308000044 |
| Provider Name | Jennifer M Bagwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790994598 PECOS PAC ID: 6800140955 Enrollment ID: I20181108002440 |
| Provider Name | Dean John Rotondo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588226575 PECOS PAC ID: 7719216191 Enrollment ID: I20190910002754 |
| Provider Name | Ian Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164061040 PECOS PAC ID: 4587095559 Enrollment ID: I20200506001777 |
| Provider Name | Airely Jimenez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588298210 PECOS PAC ID: 9133550932 Enrollment ID: I20200512000818 |
| Provider Name | Tracy Mallett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417054990 PECOS PAC ID: 8022420223 Enrollment ID: I20201211001484 |
| Provider Name | Katrina Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447538269 PECOS PAC ID: 1658785233 Enrollment ID: I20210121001896 |
| Provider Name | Jessica Yael Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295053908 PECOS PAC ID: 3779887617 Enrollment ID: I20210322000266 |
| Provider Name | Agathe Milhomme |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346600335 PECOS PAC ID: 1850797150 Enrollment ID: I20210913002466 |
| Provider Name | Norma Carrow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710551205 PECOS PAC ID: 0446648570 Enrollment ID: I20211022000929 |
| Provider Name | Pamela J Gatfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598416497 PECOS PAC ID: 8123415809 Enrollment ID: I20220427002259 |
| Provider Name | Tanya Ilaine Alonso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568103703 PECOS PAC ID: 8921475641 Enrollment ID: I20221109000085 |
| Provider Name | Suzanne Sexton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104009190 PECOS PAC ID: 9436524220 Enrollment ID: I20230504000706 |
| Provider Name | Chet Lesniak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164575064 PECOS PAC ID: 8022026798 Enrollment ID: I20230803003082 |
| Provider Name | James Jacobs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588713978 PECOS PAC ID: 4385923994 Enrollment ID: I20230830003229 |
| Provider Name | Antonette N Huff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447848809 PECOS PAC ID: 5395109995 Enrollment ID: I20230915000410 |
| Provider Name | Simone Ingram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023608825 PECOS PAC ID: 9234545336 Enrollment ID: I20230925000508 |
| Provider Name | Deborah L Wiedlund |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366569451 PECOS PAC ID: 2264888197 Enrollment ID: I20231027002124 |
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